Burks Stephen V, Anderson Jon E, Bombyk Matthew, Haider Rebecca, Ganzhorn Derek, Jiao Xueyang, Lewis Connor, Lexvold Andrew, Liu Hong, Ning Jiachen, Toll Alice, Hickman Jeffrey S, Mabry Erin, Berger Mark, Malhotra Atul, Czeisler Charles A, Kales Stefanos N
Division of Social Science, University of Minnesota, Morris, MN.
Center for Transportation Studies, University of Minnesota, Morris, MN.
Sleep. 2016 May 1;39(5):967-75. doi: 10.5665/sleep.5734.
To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) program on the risk of serious preventable truck crashes.
Data are from the first large-scale, employer-mandated program to screen, diagnose, and monitor OSA treatment adherence in the US trucking industry. A retrospective analysis of cohorts was constructed: polysomnogram-diagnosed drivers (OSA positive n = 1,613, OSA negative n = 403) were matched to control drivers unlikely to have OSA (n = 2,016) on two factors affecting crash risk, experience-at-hire and length of job tenure; tenure was matched on the date of each diagnosed driver's polysomnogram. Auto-adjusting positive airway pressure (APAP) treatment was provided to all cases (i.e. OSA positive drivers); treatment adherence was objectively monitored. Cases were grouped by treatment adherence: "Full Adherence" (n = 682), "Partial Adherence" (n = 571), or "No Adherence" (n = 360). Preventable Department-of-Transportation-reportable crashes/100,000 miles were compared across study subgroups. Robustness was assessed.
After the matching date, "No Adherence" cases had a preventable Department of Transportation-reportable crash rate that was fivefold greater (incidence rate ratio = 4.97, 95% confidence interval: 2.09, 10.63) than that of matched controls (0.070 versus 0.014 per 100,000 miles). The crash rate of "Full Adherence" cases was statistically similar to controls (incidence rate ratio = 1.02, 95% confidence interval: 0.48, 2.04; 0.014 per 100,000 miles).
Nontreatment-adherent OSA-positive drivers had a fivefold greater risk of serious preventable crashes, but were discharged or quit rapidly, being retained only one-third as long as other subjects. Thus, the mandated program removed risky nontreatment-adherent drivers and retained adherent drivers at the study firm. Current regulations allow nonadherent OSA cases to drive at another firm by keeping their diagnosis private.
A commentary on this article appears in this issue on page 961.
评估雇主强制实施的阻塞性睡眠呼吸暂停（OSA）项目对严重可预防卡车碰撞风险的影响。
数据来自美国卡车运输行业首个大规模的雇主强制项目，该项目用于筛查、诊断和监测OSA治疗依从性。构建了队列的回顾性分析：将多导睡眠图诊断的司机（OSA阳性n = 1613，OSA阴性n = 403）与不太可能患有OSA的对照司机（n = 2016）在影响碰撞风险的两个因素上进行匹配，即入职时的经验和工作任期长度；任期根据每个诊断司机的多导睡眠图日期进行匹配。为所有病例（即OSA阳性司机）提供自动调压气道正压（APAP）治疗；客观监测治疗依从性。病例按治疗依从性分组：“完全依从”（n = 682）、“部分依从”（n = 571）或“不依从”（n = 360）。比较各研究亚组每100,000英里可预防的运输部报告的碰撞事故。评估稳健性。
在匹配日期之后，“不依从”病例的可预防运输部报告的碰撞率比匹配对照组高五倍（发病率比 = 4.97，95%置信区间：2.09，10.63）（每100,000英里分别为0.070和0.014）。“完全依从”病例的碰撞率与对照组在统计学上相似（发病率比 = 1.02，95%置信区间：0.48，2.04；每100,000英里为0.014）。
未坚持治疗的OSA阳性司机发生严重可预防碰撞的风险高五倍，但很快被解雇或辞职，其保留时间仅为其他受试者的三分之一。因此，强制实施的项目清除了有风险的未坚持治疗的司机，并在研究公司保留了坚持治疗的司机。现行法规允许未坚持治疗的OSA病例通过隐瞒诊断在另一家公司驾驶。
关于本文的一篇评论发表在本期第961页。
